Menopause is a natural physiologic process that marks the end of a women’s reproductive years and typically occurs between the ages of 45 – 55. Medical menopause refers to the cessation of menses that occurs after surgery or chemotherapy. Both are characterized by a drop in estrogen, progesterone and sometimes testosterone. This drop in hormones affects each woman uniquely. Some woman have minimal symptoms while other woman may experience night sweats, hot flashes, sleep disruption, mood changes, metabolic shifts, increased joint and bone pain, bladder and vaginal issues and changes in sex drive.
Perimenopause is the transitional period leading up to the final menses. It often starts around age 40 but for some woman can occur earlier. As the ovaries start to have a more erratic production of hormones and less-frequent ovulation, hormones fluctuate which can make perimenopause feel a bit like a roller coaster from month to month. Common symptoms can include irregular periods, night sweats, mood shifts and weight gain.
Hot flashes during menopause are linked to overactivity of certain neurons (KNDy neurons) in a region of the brain called the hypothalamus. Dropping estrogen levels in menopause stimulate these neurons, causing dysregulation in how the body controls its temperature.
At the most basic level, HT replaces female hormones, primarily estrogen and progestogens, that are lost during the menopause transition. HT can be delivered orally, through the skin (transdermal), and vaginally. Estrogen can be taken alone if a woman no longer has a uterus. Otherwise, a progestogen is needed to protect the uterus from unopposed estrogen. Hormone therapy is FDA-approved as a first-line therapy for the relief of bothersome night sweats/hot flashes and is shown to be the most effective treatment. Estrogen is also FDA-approved for prevention of osteoporosis. Careful consideration of your medical history, symptoms and goals for treatment is needed to determine if and what kind of hormone therapy may be right for you. If you are not a candidate for hormone therapy or would prefer to avoid hormones, there are
nonhormonal options for treatment of night sweat and hot flashes, mood changes, and vaginal symptoms.
Bioidentical hormones have the same chemical and molecular structure as the body’s natural hormones. FDA-approved bioidentical hormone therapy products are available as prescriptions and typically tend to be covered by insurance.
